Successful laparoscopic assisted myomectomy of a gigantic 9.4 kg uterine parasitic myoma: a case report and review of literature

Uterine leiomyomas are the most common benign tumours of the female pelvis affecting around 25-30% women of reproductive age. A case of successful laparoscopic assisted myomectomy in a giant uterine parasitic myoma is presented. A 42-year nulliparous morbidly obese lady presented with an Ultrasound diagnosis of a large uterine mass, detected during routine health check-up. MRI revealed a giant uterine pedunculated myoma of size 35 × 28 × 18 cm arising from the fundus and a 6 × 7 cm posterior wall myoma. After counselling the patient regarding surgical and anaesthesia risk, need of hysterectomy and laparotomy, laparoscopic myomectomy was planned. Laparoscopic findings revealed an exceptionally large parasitic fundal myoma filling the whole abdominal cavity and another 7 × 6 cm subserous myoma. main technical challenge was to tackle the big feeding vessels from the omentum providing massive blood supply to the gigantic tumor. Laparoscopic myomectomy was completed successfully using harmonic ace for coagulating the giant feeding vessels from the omentum. As the size of myoma was too big to put in the morcellation bag, so specimen retrieval was done through small incision and manual morcellation. The weight of the specimen was 9.4 Kg. This case emphasizes that size does not pose a limit to removing these gigantic myomas laparoscopically when surgical expertise and good anaesthesia facility is available. This is the case of largest myoma managed laparoscopically

Refractive indices, density and order parameter of some technologically important liquid crystalline mixtures

Temperature variation of the refractive indices, birefringence, density and order parameter of liquid crystalline mixtures E7, E8, N10 and PCH-1132 are reported. The birefringence of PCH-1132 is found to be abnormally low compared to other mixtures

Refractive indices, density and order parameter of some liquid crystals

The temperature variation of the refractive indices (no, ne) and density are reported for two liquid crystals. The order parameter is evaluated by both Vuks' and Neugebauer's approaches. The possible sources of error in evaluating the order parameter from refractive indices measurements have been discussed. The contradictory behavior of Δ n and ΔX during the nematic-smectic B phase transition of HBT has been explained on the basis of polydomain formation and the order parameter in the SB phase is estimated. The order parameter of two liquid crystals, HBT and OBT, is also evaluated by NMR measurements, confirming the polydomain formation in the SB phase of HBT

Refractive indices, density and order parameter of two liquid crystals HBT and OBT

The temperature variation of refractive indices (ne ne), birefringence (δn), density (ρ) and order parameter (S) of two liquid crystals, namely, N-(p-hexyloxybenzylidene)-p-toluidine (HBT) and N-(p-octyloxybenzylidene)-p-toluidine (OBT) are reported in the smectic (SA in OBT and SB in HBT), nematic and isotropic phases. For accurate measurement of δn, the wedge method was modified to eliminate the need to measure the wedge angle. Density measurements indicate that the smectic-nematic and nematic-isotropic phase transitions in these materials are of first order. Using refractive index values and the density data, the internal field factors (γe, γo), the ratio of principal polarizabilities f(=αeαo) and the order parameter, S, have been evaluated and their temperature dependence discussed in the light of molecular geometry. The order parameter has been determined using the isotropic internal field model (Vuks approach) and the anisotropic internal field model (Neugebauer's approach). The S values determined using these two models agree in the nematic phase but differ considerably in the smectic phase

1,5-Dimethyl-3-oxo-2-phenyl-2,3-di­hy­dro-1H-pyrazol-4-aminium 2-hydroxy­benzoate

In the title salt, C11H14N3O+·C7H5O3 −, the phenyl ring of the cation is oriented at an angle of 67.0 (1)° with respect to the five-membered pyrazolone ring. The carboxyl­ate plane of the anion is twisted out from the plane of the aromatic ring at an angle of 13.7 (3)°. In the crystal, the cations form hydrogen-bonded dimers with an R 2 2(10) ring motif. The salicylate anion has an intra­molecular O—H⋯O hydrogen bond

Study of outcome of obstetric emergencies admitted to intensive care unit

Background: Critically ill obstetric patients pose challenges to the intensive care unit team due to their altered physiology as well as due the presence of the foetus and safety of both the mother and the foetus is of paramount importance.Methods: All antenatal and postnatal cases within 42days of delivery requiring ICU admission from October 2014 to September 2016. Detailed history taken and outcome noted. Results were subjected to statistical evaluation using SSP software.Results: (n=75): obstetric reasons (n=51, 68%) of which 21(28%) had PPH and 17(22.6) had hypertensive disorders of pregnancy. Non-obstetric reasons (n=24, 32%) of which 7(9.3%) cases had jaundice and 4(5.3%) had malaria. Mechanical ventilation was needed in the majority of cases (n=44, 58.7%) followed by inotropic support (n=30, 40%).Maternal mortality was 16%. Mortality was higher (n=8, 66.6%) among patients admitted for obstetric reasons as opposed to non-obstetric indications (n=4, 33.3%).Conclusions: Early detection and prompt referral to the tertiary centre with intensive care facilities should be promoted among the medical fraternity to reduce the incidence of ICU admissions and maternal mortality. All residents of obstetrics and gynaecology should have short mandatory training phase in critical care. Multicentre randomised studies are required for formulating evidence-based national guidelines

(E)-3-Phenyl-3-(3-phenyl-1H-1-pyrazol­yl)-2-propenal

In the title compound C18H14N2O, the pendant rings make dihedral angles of 66.1 (1)° and 13.9 (1) with the central ring. In the crystal, two mol­ecules form a cyclic centrosymmetric R 2 2(22) dimer through pairs of C—H⋯O bonds. These dimers are further connected into zigzag chains extending along the b axis through C—H⋯π and C—H⋯O inter­actions

Quantum state estimation and large deviations

In this paper we propose a method to estimate the density matrix \rho of a d-level quantum system by measurements on the N-fold system. The scheme is based on covariant observables and representation theory of unitary groups and it extends previous results concerning the estimation of the spectrum of \rho. We show that it is consistent (i.e. the original input state \rho is recovered with certainty if N \to \infty), analyze its large deviation behavior, and calculate explicitly the corresponding rate function which describes the exponential decrease of error probabilities in the limit N \to \infty. Finally we discuss the question whether the proposed scheme provides the fastest possible decay of error probabilities.Comment: LaTex2e, 40 pages, 2 figures. Substantial changes in Section 4: one new subsection (4.1) and another (4.2 was 4.1 in the previous version) completely rewritten. Minor changes in Sect. 2 and 3. Typos corrected. References added. Accepted for publication in Rev. Math. Phy

Anxiety and depression among people living in quarantine centers during COVID-19 pandemic: a mixed method study from western Nepal

Background In response to the COVID-19 pandemic, incoming travelers were quarantined at specific centers in Nepal and major checkpoints in Nepal-India border. Nepal adopted a generic public health approaches to control and quarantine returnee migrants, with little attention towards the quality of quarantine facilities and its aftermath, such as the poor mental health of the returnee migrants. The main objective of this study was to explore the status of anxiety and depression, and factors affecting them among returnee migrants living in institutional quarantine centers of western Nepal. Methods A mixed method approach in this study included a quantitative survey and in-depth interviews (IDIs) among respondents in quarantine centers of Karnali province between 21st April and 15th May 2020. Survey questionnaire utilized Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) tools, which were administered among 441 quarantined returnee migrants. IDIs were conducted among 12 participants which included a mix of six quarantined migrants and healthcare workers each from the quarantine centres. Descriptive and inferential analyses were conducted on quantitative data; and thematic analysis was utilized for qualitative data. Results Mild depression (9.1%; 40/441) and anxiety (16.1%; 71/441) was common among respondents followed by moderate depression and anxiety {depression (3.4%; 15/441), anxiety (4.1%; 18/441)} and severe depression and anxiety {depression (1.1%; 5/441), anxiety (0.7%; 3/441)}. Anxiety and depression were independent of their socio-demographic characteristics. Perceived fear of contracting COVID-19, severity and death were prominent among the respondents. Respondents experienced stigma and discrimination in addition to being at the risk of disease and possible loss of employment and financial responsibilities. In addition, poor (quality and access to) health services, and poor living condition at the quarantine centres adversely affected respondents’ mental health. Conclusion Depression and anxiety were high among quarantined population and warrants more research. Institutional quarantine centers of Karnali province of Nepal were in poor conditions which adversely impacted mental health of the respondents. Poor resource allocation for health, hygiene and living conditions can be counterproductive to the population quarantined